3.4 Percentage of applicable patients directly admitted to a stroke unit within 4 hours of clock start AND who either received thrombolysis or had a pre-specified justifiable reason (‘no but’) for why it could not be given (Thrombolysis domain)

Included: all patients who were admitted to hospital are included apart from patients whose first ward they were admitted to was Intensive Therapy Unit (ITU) / Coronary Care Unit (CCU) / High Dependency Unit (HDU) or patients who received an intra-arterial intervention for acute stroke

Excluded: patients who were first admitted to an ITU/CCU/HDU ward or patients who received an intra-arterial intervention for acute stroke are excluded from this indicator

Numerator = the number of patients who were admitted to a stroke unit within 4 hours of clock start AND either received thrombolysis or had a ‘no but’ reason for why it could not be given.Denominator = all the patients in the cohort (excluding the patients who were admitted to ITU/CCU/HDU or patients who received an intra-arterial intervention). Patients who did not stay on a stroke unit and/or patients where the reason for not being thrombolysed was “No” (Q2.6 is No) are included in the denominator.

To calculate whether a patient is included in the numerator:

Firstly, identify the number of patients where “Stroke Unit” is the first ward the patient was admitted to at the first hospital (Q 1.14) and who did not receive an intra-arterial intervention (Q2.11 is “No”).

Then identify the number of those patients:

newly arrived to hospital where the difference between the date and time of arrival (Q 1.13) and the date and time the patient first arrived on the stroke unit (Q 1.15) is less than or equal to 240 minutes.

already in hospital where the date and time of symptom onset (Q 1.11) and the date and time the patient first arrived on the stroke unit (Q 1.15) is less than or equal to 240 minutes

Lastly, identify the number of those patients who were thrombolysed or had a justified reason as to why not (Q2.6 is” Yes” or “No but”).

Cohort percentage:

For team-centred

For patient-centred

All patients in the team-centred 72h cohort except those who went to ITU/CCU/HDU or received an intra-arterial intervention

All patients in the patient-centred 72h cohort except those who went to ITU/CCU/HDU or received an intra-arterial intervention

ExamplePatient Q arrived (clock start) at hospital at 18:57 on Wednesday. They were admitted to the stroke unit at 20:57 that same day. They were thrombolysed.Patient Q has achieved the indicator. They were admitted to a stroke unit in 120 minutes and were thrombolysed.Patient R arrived (clock start) at hospital at 14:15 on Sunday. They were admitted to the stroke unit at 20:16 that same day. They were thrombolysed.Patient R has not achieved this indicator. They were admitted to the stroke unit in 361 minutes (above 4 hours) and were thrombolysed.Patient S had an onset in hospital (clock start) at 20:08 on Saturday. They were not admitted to a stroke unit, they stayed on a general ward (MAU/AAU/CDU).Patient S has not achieved this indicator as they were not admitted to a stroke unit.Patient T arrived (clock start) at hospital at 03:45 on Tuesday. They were directly admitted to HDU.Patient T is excluded because they were admitted to HDU.Patient U arrived (clock start) at hospital at 08:57 on Monday. They were admitted to the stroke unit at 10:57 that same day. The reason for not being thrombolysed was a justifiable ‘no but’ reason.Patient U has achieved the indicator. They were admitted to a stroke unit in 180 minutes and were not thrombolysed with a ‘no but’ reason.Patient V had an onset in hospital (clock start) at 04:01 on Tuesday. They were directly admitted to the stroke unit at 06:30 that same day. The reason for not being thrombolysed was a ‘no’ reason.Patient V has not achieved the indicator. They were admitted to a stroke unit in 159 minutes but the reason for not being thrombolysed was a ‘no’ reason.Patient W arrived (clock start) at hospital at 13:45 on Tuesday. They received thrombolysis and an intra-arterial intervention and were then admitted to the stroke unit at 16:45.Patient W is excluded because they received an intra-arterial intervention, even though they were admitted to the admitted to the stroke unit within 4 hours and received thrombolysis.